**9. Conclusions**

• If oedema is not significant, exercises begin with passive flexion of the digits with active

• Once these exercises are completed, the patient begins with active flexion exercises where a finger of the opposite hand is placed in the palm of the affected hand and the patient flexes the affected fingers against the contralateral fingers aiming to progress one finger width per week.

• By the end of the first week, the patient should have full passive flexion, full active exten-

• The splint is discontinued between weeks four and six (week four for patients with poor tendon gliding and six for those that have excellent ROM defined as full active fist at week

• At week six, blocking exercises of the individual joint is commenced. At this stage, a splint

• Strengthening begins 3 weeks after the dorsal block splint is discontinued. Strengthening

None of the EAM protocols should be followed exactly- the surgeons and therapist must individualise treatment to patient circumstances [39, 59]. For example, advancement to the next phase of a protocol may need to be quicker or slower based on the level of oedema, passive versus active flexion lags, and adhesion formation [59]. Interestingly, the initiation of rehabilitation is a critical factor in successfully rehabilitating flexor tendon repairs. Initiating therapy by postoperative day five has been shown to decrease the rate of secondary procedures and decrease costs of treatment irrespective of whether or not a passive or active

The most common complication of flexor tendon surgery are tendon adhesions which can limit the range of movement of the tendon. This is followed by re-rupture, joint contracture and triggering of the fingers. There is a 15–25% re-rupture rate after surgical repair [61].

• if the sheath is intact and allows passage of a paediatric urethral catheter or vascular dila-

Rarer complications of flexor tendon injury repairs are Swan-neck deformity, Lumbrical plus

two). The exercises at this time consist of passive ROM and active ROM.

progresses to allow patient to have full hand function by week 12.

extension to the constraints of the splint.

32 Essentials of Hand Surgery

sion and PIP active flexion to 30°.

protocol is used [60].

**8. Complications of primary repair**

Treatment of re-rupture of tendons is as follows [61]:

• if >1 cm of scar is present, perform tendon graft

tor, perform primary tendon grafting

finger, and Quadrigia effect.

• if <1 cm of scar is present, resect the scar and perform primary repair

• if the sheath is collapsed, place Hunter rod and perform staged grafting

may be needed to correct any flexion contractures.

Flexor tendon injury outcomes are unsurpassed when they are treated at an early stage. Good surgical technique is vital in to avoid rupture or adhesions. However, of equal importance is the preparation of the patient to expect an individualised long and complex rehabilitation programme.

Secondary reconstruction is complex and rarely results in the same level of function as a successful primary repair.
